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They played for their country in their 20s. By their 40s, they had early onset dementia after playing this physical sport

Steve Borthwick of England battles Wales' Alun Wyn Jones (L) and Alix Popham in the RBS Six Nations Championship in 2008. (Paul Harding/Action Images/Reuters) Steve Borthwick of England battles Wales' Alun Wyn Jones (L) and Alix Popham in the RBS Six Nations Championship in 2008. (Paul Harding/Action Images/Reuters)
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By the time Alix Popham had reached his late 30s, he was finding some day-to-day tasks confusing and difficult.

Popham鈥檚 wife, Mel, would have a conversation with her husband and an hour later he would have 鈥渘o recollection,鈥 he tells CNN Sport.

鈥淚 was putting it down to kids, everyday living 鈥 I was making excuses,鈥 says Popham, now a 44-year-old father of three and business owner.

Then in September 2019, Popham went on a bike ride, got lost and blacked out.

A former professional rugby union player, Popham started playing the sport at the early age of four and it quickly became his life.

鈥淏y the age of six, seven, I realized, and people realized, that I was pretty good at it,鈥 Popham, who played for top clubs in France, Wales and England and represented his home country, Wales, at two Rugby World Cups.

鈥淢y memory of playing and specific games 鈥 is not really there. I鈥檝e got no feelings or memories of being in stadiums,鈥 he says.

Lenny Woodard followed a similar trajectory to Popham, starting rugby at 10.

Both men went on to earn a living from the sport they loved.

By the time they had reached their 40s, their professional sporting careers ended and both Woodard and Popham, and their families, soon noticed something was very wrong.

Woodard worked as a salesman and began experiencing similar issues to his compatriot.

鈥淚 was losing track of conversations. People were telling me something and then I forgot what they said, I鈥檇 have to ask them to repeat the question,鈥 says Woodard, who represented Wales in the two rugby codes of union and league.

鈥淚鈥檇 forget their name, even though I鈥檇 been speaking to them two minutes before,鈥 Woodard, 47, says.

Both men saw doctors, and within months, were given the same devastating news: not only did they have early onset dementia, but also, probable chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repeated head trauma.

Popham was just 40 and Woodard 45.

The neurodegenerative brain disease CTE, which can only be formally diagnosed after death and autopsy, is pathologically marked by an abnormal buildup of a protein called Tau, in the brain that can disable neuropathways and lead to , including memory loss, confusion, impaired judgment, aggression, depression, anxiety, impulse control issues and sometimes suicidal behaviour.

Popham and Woodard are two of more than 450 current and former rugby players who have now joined lawsuits to take legal action against global governing body World Rugby and the national governing bodies of England and Wales, the Rugby Football Union (RFU) and the Welsh Rugby Union (WRU), Rugby Football League Limited, International Rugby League Limited and British Amateur Rugby League Association.

鈥楨xistential threat鈥 to the game

Lawyers for the plaintiffs  there was a failure to protect them from permanent injury caused by repeated head injuries and concussions during their careers.

These governing bodies, the claimants allege, 鈥渨ere negligent in failing to take reasonable action in order to protect players from permanent injury caused by repetitive concussive and sub-concussive blows,鈥 according to a press release sent to CNN Sport by attorneys for the plaintiffs.

Richard Boardman, the lawyer representing the claimants, told CNN Sport that this is causing an 鈥渆xistential threat鈥 to the game.

CNN has reached out to the International Rugby League Limited and British Amateur Rugby League Association for comment about the lawsuits.

The Rugby Football League Limited told CNN in a statement that 鈥渨hile there is an element of risk to playing any sport, player welfare is always of paramount importance.

鈥淎s a result of scientific knowledge, the sport of Rugby League continues to improve and develop its approach to concussion, head injury assessment, education, management and prevention across the whole game,鈥 the league added.

In a joint statement sent to CNN Sport, World Rugby, the RFU and WRU said they could not comment on the ongoing legal proceedings.

鈥淧layer welfare has been and will continue to be our top priority and we constantly strive to safeguard our players, acting on the science and evidence, enacting our six-point plan to make rugby the most progressive sport in the world in this area,鈥 they said.

The organizations noted that the sport鈥檚 Head Injury Assessment (HIA) during games, which follow a three-stage process to assist with the identification, diagnosis and management of head impact events with the potential for a concussion 鈥 are 90% accurate when diagnosing a concussion, citing a paper published in the Springer scientific journal.

But experts warn that such protocols don鈥檛 really address the issue of playing collision-based sports and repeated head trauma.

鈥淎s far as the brain is concerned, it doesn鈥檛 matter what sport is played,鈥 Michael Grey, a neuroscientist at the University of East Anglia, told CNN Sport. 鈥淚f we get a knock to the body that causes a wobble of the brain inside the cranium, that鈥檚 going to produce some damage.鈥

Chris Nowinski, an advisor to the National Football League Players Association (NFLPA) and founding CEO of the Concussion Legacy Foundation told CNN Sport that head injury protocols need to go beyond treating concussion.

鈥淭here鈥檚 a very straight linear correlation between head impacts and CTE. And there鈥檚 studies that will suggest for every one concussion the American football player suffers, they鈥檒l have 300 hits that are harder than that concussion,鈥 he said.

Nowinski, a World Wrestling Entertainment (WWE) wrestler turned neuroscientist, explains that because the brain doesn鈥檛 have pain nerves, a person can鈥檛 necessarily feel when it鈥檚 being damaged, and therefore, most brain injuries don鈥檛 produce the symptoms that would be detected by a HIA.

Nowinski told CNN Sport that in most professional sports, head injury protocols are 鈥渘ot designed to be safe: they鈥檙e designed to allow the business of the game to move forward in a way that is agreeable for the players.鈥

Ann McKee, director of the Boston University CTE Center has also previously told CNN Sport that 鈥渟ubclinical hits 鈥 the non-concussive injuries that aren鈥檛 detected 鈥 you don鈥檛 pull the player off the field, and they can be in the hundreds or even the thousands in a single season.鈥

Boardman, who is representing the rugby claimants, told CNN Sport: 鈥淲e believe that up to 50% of elite players that play post 1995, when the sport went professional, will end up with some kind of neurological impairment.鈥

Rugby is split into two main codes, rugby league and rugby union, which went professional in 1995. Since the sport went professional, players have become stronger, bigger and faster. In 1955, mean male player body mass was 84.8 kilograms (about 187 pounds). By 2015, it had increased by 24.3% to 105.4 kilograms (232 pounds), according to a study published in the British Medical Journal Open Sport & Exercise Medicine.

鈥榃obble to the brain鈥

The rugby lawsuit comes a decade after the NFL reached a US$765 million settlement in a case involving more than 4,500 players who accused the league of failing to warn and protect them from the long-term risks of repetitive traumatic brain injuries, despite being aware of the evidence and associated risks.

The NFL denied any wrongdoing, but according to NFL.com, commissioner Roger Goodell  to 鈥渄o the right thing for the game and the men who played it.鈥

To date, NFL parties have  over $1 billion in monetary awards as part of the program.

The agreement provides up to $5 million per retired player for serious medical conditions associated with repeated head trauma.

The NFL publicly acknowledged a connection between American football and CTE for the first time in 2016.

Boardman told CNN Sport that rugby players face regular head trauma on a scale far greater than those in the NFL, given that more games are played and contact in training is not limited like it is in American football.

鈥淭hat鈥檚 why we believe rugby is on a scale unlike NFL, unlike football [soccer], any other contact sport,鈥 he said.

Grey, the neuroscientist, says that many sports governing bodies 鈥 including rugby 鈥 continue to distance themselves from CTE. World Rugby denies this, saying in a statement that it 鈥渃onstantly reviews all of the available evidence and our track record consistently shows that we follow the latest scientific data and expert opinion.鈥

Their attitude, Grey says, resembles: 鈥淚t鈥檚 not our problem. It鈥檚 American football. It鈥檚 ice hockey. It鈥檚 these high-impact sports that have the problem. Well, we know now that鈥檚 not true.鈥

鈥淭hey鈥檝e taken a very, very long time to get on board with the notion that we need to reduce the incidence of injury in practice and in play. And they鈥檝e really come along with this kicking and screaming,鈥 he said.

鈥淚t鈥檚 the business of the game that seems to be far more important than the player welfare,鈥 Grey adds.

McKee tells CNN Sport that, when it comes to sports leagues and head injury, 鈥渢here鈥檚 a generalized denial that it鈥檚 an issue.鈥

A new study from the University of Glasgow, Boston University and the University of Sydney which looked at the post-mortem brain exams of 31 former amateur and elite rugby union players found CTE in 68% of the brains, which had been donated for research purposes.

Researchers found that the risk of CTE pathology was associated with the length of a player鈥檚 career, noting that each additional year of play added 14% to the risk of CTE 鈥 regardless of whether a player was amateur or elite and their position or level of participation. The men whose brains were donated for study had an average rugby career length of around 18 years.

And in a 2022 study from the University of Glasgow, researchers found the risk of developing neurodegenerative disease later in life among former Scottish international rugby union players was nearly triple that of people with the same socio-demographic profile.

The , which looked at 412 Scottish former international male rugby players aged 30 and above and 1,236 members of the public who had been matched for age, sex and socioeconomic status, found that the rugby players鈥 risk of a dementia diagnosis over time was just over twice as high.

Meanwhile, their risk of developing Parkinson鈥檚 disease by the time of a follow-up with researchers was three times as high, and that of motor neurone disease (MND) or amyotrophic lateral sclerosis (ALS) 15 times as high.

World Rugby noted that its concussion protocols have evolved and have been revised in 2012, 2014, 2019, 2021 and 2022 to increase substitution time and adapt tests for concussion.

鈥淭he temporary substitution time period has proven successful in assisting medical staff to assess and make an informed decision regarding the removal of players when suspected concussion is not clear,鈥 states World Rugby on its site.

鈥淭he entire process includes strict side-line assessment based on the best available evidence and rigid follow-up procedures.鈥

And, in October, World Rugby  it will advance the Head Injury Assessment (HIA) by introducing in-game alerts linked to smart mouthguards 鈥渢o show if a player has experienced a high level of acceleration which could lead to an injury.鈥

However, Woodard and Popham, the former rugby players, both point out that there is a pressure to carry on playing even after having sustained a head injury.

In the late '90s and early 2000s, 鈥渦nless your leg was hanging off, you were encouraged to stay on regardless of what happened,鈥 Woodard explains.

鈥淭hat stigma still exists to a certain extent today, although it鈥檚 been radically improved in the last 10 years or so.鈥

Popham adds: 鈥淩ugby players, they鈥檙e gladiators 鈥 especially at the moment with a shortage of clubs and jobs out there 鈥 they don鈥檛 want to miss a game because they鈥檙e fighting until their next contract 鈥 But it needs to be taken out of the players鈥 hands.鈥

鈥楶arents aren鈥檛 told this鈥

Many fans believe that the same players who are seeking compensation have the potential to ruin the sport, according to Woodward and Popham.

鈥淭here鈥檚 a lot of people who are judging us because they think we鈥檙e attacking the game. And what we鈥檙e actually trying to do is make the game safer,鈥 Woodard explains.

鈥淧eople are going to comment on this, things like: 鈥楳y mom had dementia, and she never had any compensation,鈥 stuff like that. Your mom was diagnosed at 70. I鈥檓 in my early 40s. There鈥檚 a huge difference.鈥

Woodard says he is now dealing with a steep decline in his cognitive function.

鈥淲hen I go back up to Wales to pick my children up, if I want to take them to a park or a trampoline park or something of interest to them, I can鈥檛 compute how to get there, even though I lived in Wales for over 40 years of my life,鈥 he says. 鈥淲hereas five years ago, I could do it perfectly.鈥

Both men are adamant that more needs to be done to protect future and current players.

Popham says that this doesn鈥檛 just extend to the professional game, with children playing the sport every day.

鈥淧arents aren鈥檛 told this. My mom broke down when I got my diagnosis, saying she shouldn鈥檛 have sent me to rugby. I said, 鈥榊ou weren鈥檛 told, you weren鈥檛 informed.鈥 And that鈥檚 still the case to this day. I don鈥檛 think parents are told the correct information on this issue.鈥

Governing bodies England Rugby and Welsh Rugby Union have codes of practice indicating how contact in youth rugby should be managed by coaches, and which age groups can play together.

The latest study from Boston University鈥檚 CTE Center shows 鈥渢hat CTE can start in very young athletes who only play amateur sports,鈥 said McKee, co-author of the study, said of the paper published in the journal .

The study of 152 brains from athletes who were under 30 at the time of their death discovered more than 60 cases of CTE, with the youngest person diagnosed with CTE in the study only 17.

The majority of those diagnosed were amateur athletes who played sports including soccer, football, ice hockey, rugby and amateur and professional wrestling at the youth, high school and collegiate levels.

Woodard says that he has seen other former players in their 40s start to deteriorate and is aware that men in his cohort have died by suicide or been institutionalized for mental health conditions.

鈥淧sychologically, I try not to think about it. The way I鈥檝e decided to approach this is: the serious decline might never happen.鈥

Woodard adds he accepts that, in 10 or 15 years, he might be unable to care for himself and have to be admitted to a care home.

Still, he says, when he hears of suicides and mental health issues in players of his age or from his cohort, 鈥測ou can get yourself in a whole spiral of doom.鈥

Experts are clear that they don鈥檛 want to discourage people from playing sports.

鈥淲e could be getting people off the pitch when we recognize they are concussed. And we should be teaching players about the dangers of concussion,鈥 said Grey.

Nowinski, the NFLPA advisor, adds: 鈥淲ith all the reforms the NFL has made, it has never been more profitable and more popular than it is today.

鈥淗opefully, the lesson for rugby here is: you can make radical changes to the game, to make it safer, more ethical and protect the next generation.鈥

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